Headache Surgery

Understanding headache surgery requires knowing the role trigger sites play in headaches. The most appropriate surgical approach is determined from the sites where your headaches are triggered. Not all headache patients are surgical candidates. The ideal candidate would have exhausted traditional headache treatments with limited or no success.

TRIGGER SITES

There are 4 common headache trigger sites:

Frontal - In the forehead

Temporal - At either temple

Rhinogenic - In the nasal area

Occipital - At the back of the head

Less common trigger sites exist as well, including the area right above or behind the ear.

COMPRESSED NERVES

The trigeminal nerve is the largest cranial nerve in the body. Branches of the trigeminal nerve can become compressed at trigger sites by adjacent structures such as muscles, vessels, bones, and cartilage. This can ultimately inflame nerves and membranes surrounding the brain causing trigger symptoms such as nausea, vomiting and sensitivity to light and sounds which are commonly described prior to headache onset.

RELIEVING PRESSURE

Relief is provided by either releasing muscle fiber or freeing nerves through decompression surgery. The specific nature of the surgery depends on the trigger site:

FRONTAL Dr. Alizadeh releases the "frowning" muscles between the eyes – called the glabellar muscles – which irritate nerve branches on both sides and lead to headaches.

TEMPORAL A tiny branch of the trigeminal nerve is released. This nerve provides feeling to the area.

RHINOGENIC Patients whose headaches are triggered intra-nasally may have a deviated septum, or enlarged turbinates coming in contact with the septum. Prior to surgery, each patient will undergo a computer tomography (CT) scan to help identify such abnormalities.

OCCIPITAL The occipital nerve runs down the back of the head and may be compressed by surrounding muscle or vessels. During surgery, the muscle is removed from around the nerve to release the nerve and alleviate pressure.

IDENTIFYING APPROPRIATE SURGERY CANDIDATES

Once it's determined that you suffer from chronic headaches and that traditional treatments to manage the condition aren't working, you will be asked to carefully chronicle your headaches in a diary for 4 weeks.

Other steps involved in determining if headache surgery is appropriate include undergoing a full physical and neurological exam by a member of our multidisciplinary team. At this time lab work and radiographic imagining such as computer tomography (CT) scans will be ordered to rule out any organic cause of your symptoms. Nerve block injections to identify headache trigger sites as well as the use of Onobotulinumtoxin A (BOTOX®) injections may be necessary to confirm that you are a good surgical candidate.

Finally, patients deemed good surgical candidates will need pre-operative medical clearance prior to surgery. Keep in mind that a headache is a dynamic condition and someone who is not presently a good candidate may become suitable for surgery in the future.

UNDERGOING HEADACHE SURGERY

The outpatient procedure is minimally invasive and typically takes 2 hours or more, depending on the number of headache trigger sites. Following surgery patients are continuously monitored from a surgical standpoint as well as seen by a multidisciplinary team including neurology and pain management.

SIDE EFFECTS

Very few side effects have been observed, but they include temporary hollowing at the temple and numbness in affected areas. Some side effects may also produce beneficial outcomes:

Fewer forehead wrinkles for patients who have the "frowning" muscles removed

Improved breathing for some patients whose headaches are triggered in the sinus area

Other side effects typical of any surgical procedure, such as bleeding or infection, are rare.

RECOVERY

Swelling and bruising is common following the procedure. This generally lasts about a week to 10 days. There will be tubes placed temporarily under your scalp to help drain fluid from the surgical site. These drains are removed 2-4 days following surgery. Patients who undergo septum surgery may need to irrigate the nose daily for up to six weeks. Strenuous activity should be avoided for 3 weeks. Use of headache medication should significantly diminish following successful surgery.

THE SCIENCE BEHIND THE SURGERY

A cure for headaches may sound too good to be true, however, there are several studies that have confirmed the minimally invasive surgical procedure’s efficacy. Please click the links below to read more about those studies.